Ureteral Transplantation for Exstrophy and Carcinoma of the Bladder

Exstrophy of the bladder is one of the most unfortunate and pathetic of all congenital anomalies. According to the statistics of Neudörfer,1 it occurs approximately once among every 50,000 births and it is stated that 50 per cent of the children who have this anomaly die before they attain the age of ten years, and that 66 per cent die before the twentieth year, unless relief is afforded by surgical intervention.

The late Dr. Robert C. Coffey deserves the gratitude of the profession for his valuable contributions in the development of the operation for the transplantation of the ureter into the recto-sigmoid. In 1911 he2 emphasized the importance of utilizing the valve principle in this operation, and the basis for this contribution was afforded by observations of the anatomical relationships of the common bile duct in its course through the walls of the duodenum. Dr. Coffey noted that this duct courses through the muscularis and then between the muscularis and mucosa of the duodenum for some distance before it opens into the lumen of the duodenum itself.

Since the adoption of the valve principle in the transplantation of the ureters, the operation has been performed frequently and has been accepted as a sound and justifiable surgical procedure. Dr. Coffey, however, stated two objections to the procedure which have prevented its general acceptance by surgeons. The first was that it is impossible to maintain uninterrupted kidney function and not alter the normal physiologic processes of the upper urinary tract when both. . .